Ask Charlotte experts: What can be done if perimenopause symptoms affect intimacy?

Welcome to Sex, Sweat and Sanity, CharlotteFive’s Q&A column about all things intimacy and perimenopause, answered by our experts.

Rachel Murray is a nurse practitioner who specializes in menopause and sexual medicine. Liz Mallers is a certified sexologist who specializes in intimacy and pleasure. She owns Liz Mallers Sexology.

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I am 45 years old and beginning to experience night sweats, hot flashes and vaginal dryness. My symptoms have been affecting my intimate life. Can you speak to this?

Rachel:

This is a very common experience for women in their 40s and is often an early sign of perimenopause, the transition phase leading up to menopause. During this time, estrogen levels fluctuate unpredictably rather than steadily declining, which can trigger symptoms such as hot flashes and night sweats.

Hot flashes and night sweats — often referred to as vasomotor symptoms — can range from mildly bothersome to significantly disruptive. They may interfere with sleep, concentration, mood, overall quality of life, and yes! Intimacy! If a woman is not feeling well, then this can certainly impact her desire.

Hormonal fluctuations during perimenopause can also affect vaginal health, causing dryness, which leads to painful intimacy or lack of sensation with intimacy. This can be quite uncomfortable and women may suffer for years prior to getting help.

There are effective, well-studied treatment options for hot flashes, night sweats and dryness, including both hormonal and non-hormonal therapies. Care can be individualized based on symptom burden, medical history and personal preferences, with the goal of improving sleep, comfort, and daily functioning.

Open conversation is key. Early evaluation allows symptoms to be addressed proactively rather than reactively. Women do not need to “push through” disrupted sleep or persistent heat episodes as a normal or unavoidable part of aging. They do not need to “push through” dryness and pain.

If hot flashes or night sweats are affecting your sleep, energy or sense of well-being, it’s worth discussing with a knowledgeable clinician. Relief is possible, and care can be tailored long before symptoms become overwhelming.

Liz:

Feeling uncomfortably hot and sweaty doesn’t exactly lead to hot and steamy sex. Pair that with vaginal dryness, and you likely aren’t feeling too motivated to start (or continue) playtime with your partner. It’s important to clue your partner in to the symptoms you’re experiencing. While it may seem obvious that you’re struggling to feel comfortable on the day-to-day, your partner may not fully connect the dots to how this might affect your intimacy.

Invite your partner to have a conversation with you about how your current symptoms are affecting your intimacy. Consider the barriers it puts on your physical, mental and emotional wellbeing.

Do you worry that your partner might get frustrated if you have to stop in the heat of the moment because of, well, too much heat? Speak to that. Is the interrupted sleep from night sweats causing more stress and therefore lowering your sex drive? Speak to that, as well. Talking with your partner will help them support you better, which will ultimately keep your general intimacy connected.

In terms of vaginal dryness, lean on the help of store-bought lube. Without proper lubrication, not only can intercourse be painful, but it puts your tissue at a much higher risk of tearing due to the dry friction. These microtears make you more susceptible to bleeding/spotting, pain and infection. A body-safe lubricant is your best bet when your natural lubrication isn’t readily available.

Some people are hesitant to purchase lube because they don’t know where to start. It’s true that the lube market is oversaturated with tons of options, ranging in ingredients, price and even flavors. Here is a brief breakdown:

Silicone-based lube is a crowd favorite with its thick viscosity and long-lasting nature. The only caveat: don’t use it with silicone toys. Over time, that silicone will start to break down and get sticky.

Water-based lube is great for those using lube with silicone toys and is generally the easiest to clean up. This type of lube will need more frequent reapplication since it will evaporate more quickly than the others.

Oil-based lube typically lasts the longest, but be aware that oil traps bacteria. If you have a sensitive vagina or are prone to yeast infections or bacterial vaginosis, avoid oil-based lubes.

As a general rule of thumb, avoid any lubes that are flavored or dyed. I highly recommend the trusted brands Uberlube (silicone-based) or Good Clean Love as a starting point.

The bottom line

If you are experiencing night sweats, hot flashes or vaginal dryness, it’s never too early to speak with a qualified clinician for early intervention. Have intentional conversations with your partner about how your symptoms are affecting you, and grab yourself a bottle of lube to make intimate moments more comfortable and desirable. And of course, reach out to professionals like Rachel and Liz for extra support when needed.